Alternative To What?
I was shocked this past week, at the Human Behavior and Evolution Society conference when a British researcher who actually uses data in her work told me she uses homeopathy and some other crapthink medical treatment I can't remember. Here's a quote for her:

“There cannot be two kinds of medicine - conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works, and medicine that may or may not work.”

--from a 1998 New England Journal of Medicine editorial by then-editor-in-chief Marcia Angell and former editor-in-chief Jerome P. Kassirer

And here's Steven Novella, from whose blog I pulled the above quote, debunking the crapthink that is homeopathy. (The letter he quotes from is by Peter Fisher, director of the Royal London Homeopathic Hospital. Novella calls it "a droll patchwork of unsupported assertions, straw men, propaganda, and assorted other logical fallacies.")

Fisher writes:

But we do not shy away from the scientific debate around homeopathy. Homeopathy is enigmatic: remarkably popular, widespread and persistent, despite the scepticism of. It is simply not true to say that it is unsupported by evidence. A review of 119 randomised, peer-reviewed clinical trials of homeopathy at the end of 2005 showed 49% positive results for homeopathy. Only 3% were negative. Economic studies consistently show that integrating homeopathy in medical practice results in better outcomes for the same cost.

Fisher states that homeopathy is enigmatic, but what he really means is that popular support for homeopathy is the enigma because that popularity is in the face of extreme scientific implausibility and a lack of adequate evidence.

He then tries to characterize skepticism toward homeopathy as outdated and obsolete by making a personal attack against “retired professors of biomedical background.” Well how about the skepticism of the majority of the scientific community? How about the skepticism of this working academic clinician? How about the appropriate skepticism of anyone who knows the slightest thing about chemistry and physics?

Fisher’s characterization of the scientific evidence for homeopathy reveals his poor scholarship in this area. Yes, there are many studies in homeopathy, and yes many of them are positive. But he fails to address the actual criticism of this research leveled by homeopathy’s critics – that there is an inverse correlation between the quality of the study and the size of any effect, and the best studies (the only ones actually worth considering) are all negative. The fact that there are many poor quality and biased studies of homeopathy out there (combined with the file drawer effect as an added bias toward publishing positive studies) is meaningless. Proponents of homeopathy have failed to produce a single positive study that is adequately designed, controlled, and executed.

They have also failed (and Fisher fails to even discuss this) to provide an adequate explanation for why the claims of homeopathy are not impossible within the framework of modern science. Homeopathy is nothing more than pre-scientific witchcraft. Its “laws” are rituals based upon magical thinking. There is no mechanism how, even with the most creative theories possible within the framework of science, that water can retain the memory of complex molecules that have been diluted within it in the past (and only the ones desires – not all the other molecules that have been diluted in that water previously).

Given that we know, as much as we know anything in science, that homeopathic “remedies” are just water and cannot possibly have any therapeutic effect beyond a placebo effect (homeopathic pills are literally placebos) – what the body of homeopathic research actually teaches us is something quite different than what Fisher concluded. It is showing us what a body of clinical research will look like when the underlying phenomenon does not exist. It is showing us why we need carefully controlled trials that rule out fraud and bias. It is showing us the effects of self-deception, and the statistical effects of publication bias. It is showing us the weaknesses of meta-analysis, and the many ways in which statistics can be manipulated to create the appearance of an effect where none exists.

Posted by aalkon at June 6, 2007 12:50 PM

Comments

People who use homeopathy drive me nuts. Here is a video of James Randi describing the rules of homeopathic treatments at Princeton:

Oh, facts facts facts. Next you'll be telling us that Red Bull doesn't give us wings.

Posted by: Paul Hrissikopoulos at June 6, 2007 6:54 AM

With acknowledgement to "Cromulent Kwyjibo" who wrote the equivalent in the wikipedia discussion page on numerology:

There was an episode of Family Guy in which a theater director says: "Let's remember our performance hierarchy. Legitimate theater, musical theater, stand-up, ventriloquism, magic, mime."

When it comes to medicine, the hierarchy is "scientific medicine, herbal medicine, coincidences, dog poo, homeopathy."

Posted by: Stu "El Inglés" Harris at June 6, 2007 7:17 AM

I can't see a Red Bull advert without wondering whether it contravenes the advertising standards of "honesty, truthfulness and decency", since it patently does not give you wings.

There's a common thread to religion and conspiracy theories, whether they are about the Illuminati or Big Pharma, namely that there is a hidden, powerful entity that can tamper with evidence at will to further its own interests, whatever they may be. Therefore evidence-based arguments are of no avail. It is always frustrating when someone purports to be presenting an evidence-based case, but it really just amounts to special pleading.

Posted by: Norman at June 6, 2007 7:32 AM

Stu, you got the order perfectly right.

I sat next to a "big pharma" guy on the plane -- a guy working on diabetes drugs. I'm very grateful to big pharma. The notion that the "natural foods" industry is somehow morally better is such hogwash. Like they aren't in it for the money! I'll take drugs that are proven to actually work, thanks, over those recommended, based on nothing, by some gray-skinned hippie in a health food store.

Or they use the dreaded AMA conspiracy theory of eliminating their natural competitors.

Posted by: Joe at June 6, 2007 8:38 AM

Gorgeous, Amy.

Posted by: Jody Tresidder at June 6, 2007 8:57 AM

Merriam Webster defines homeopathy as: " a system of medical practice that treats a disease especially by the administration of minute doses of a remedy that would in healthy persons produce symptoms similar to those of the disease"

Under that definition, there is one brand of homeopathy that allopathic medicine uses on a regular basis. That is: allergy shots. I've been receiving them for close to 30 years to alleviate my allergy symptoms and they work.

Posted by: moe99 at June 6, 2007 9:57 AM

moe99-

I'd question Miriam Webster's use of "minute". "Non-existent" would be more accurate. Even homeopaths agree on this, since they talk about the vibrations and memory of the original substance being present, not the substance itself.

I'll bet that your allergy shots contain more than just water!

Posted by: Norman at June 6, 2007 10:29 AM

You should have seen the scene when my mother-in-law calmly told everyone that she wasn't getting chemo but instead was going to use a homeopath treatment to treat her cancer. She refuses to take real medications because of all sorts of Big Pharma conspiracy theories.

What do you say to someone like that? Aside from "good=bye"?

Posted by: Psyke at June 6, 2007 11:10 AM

I get allergy shots too. But the shots start off weaker and get stronger as my immune system adjusts.

Homeopathic medicine supposedly gets more potent the more times it's diluted. Quackwatch.com is a great place to learn more about the un-science of homeopathy.

P.S. Did you hear about the homeopathic patient who forgot to take his medicine?

He died of an overdose.

Posted by: cjumper at June 6, 2007 11:24 AM

Sad, Psyke. Perhaps use her own "logic" against her. Boiron, a leading homeopathic "medicine" company, is a multi-million-dollar business. They aren't in it for the luvvvvv.

People are comforted by the idea that "natural" and "organic" treatments are somehow superior to "unnatural" and "artificial" ones because they like to think that the natural state of affairs is for humans to grow, live and give birth easily and safely. In reality, the natural state of affairs calls for no such thing. The comfortable life we all have in the First World depends enormously on interventions ranging from sewer systems to vaccinations to sterile procedures to drugs to surgery. That may not be pleasant or romantic to think about, but it's true. Me, I like living in an era in which people without thyroids can take replacements, and small-boned women can safely give birth to 10-pound babies through C-sections, and my delicate skin can be protected from the sun by a cocktail of chemicals. Obviously, however, others differ. Interestingly, though, I notice those others always seem to be well-off First Worlders who live highly "unnatural" lives with the exception of a few championed selections. Funny, that.

Posted by: marion at June 6, 2007 12:05 PM

It would all be so much funnier if it weren't so dangerous, as Psyke so pointedly notes.

I nearly threw my shoe at the TV when, during a recent Grey's Anatomy, one of the main characters visited her friend's private L.A.-based practice, which prominently featured an "alternative" witch doctor.

How do these quacks not get sued?

Posted by: snakeman99 at June 6, 2007 1:43 PM

In 1994, Congress passed the Dietary Supplement Health and Education Act (DSHEA) This act would stop any FDA regulation into the dietary-medicinal supplements industry under strict guidelines. The only way the FDA can regulate a product is when it is already proven that the particular supplement is already dangerous while out in the market. Under DSHEA it is voluntary for supplement companies to maintain product standards. So you are taking a chance when you buy that overpriced bottle of nothing.

Posted by: Joe at June 6, 2007 2:46 PM

I am not defending homeopathy, but we shouldn't ignore the power of the placebo effect. In fact, we should learn how to amplify it.

Someone is ill, you give them a sugar pill and tell them they'll get better, and they get better. That's some powerful magic that we should learn about.

And just because homeopathy is insane crap doesn't mean big pharma has your best interest at heart. Big pharma has big pharma's share holder interests at heart and Milton Friedman wouldn't have it any other way.

Big pharma has to come up with big pharma like remedies because to come up with little pharma remedies won't make the shareholder's happy. And so big pharma has brought out drugs they know to be ineffective, or no more effective than a drug that is already being marketed that they can't patent.

And big pharma can't patent (yet) the placebo effect.

Be wary about them both.

Posted by: jerry at June 6, 2007 8:52 PM

(large, heavy sigh)
I have, for the most part, given up on dealing with this bullshitery. Like religion, people with believe the crap they believe regardless of reality. As for those who say it is ‘big pharma’ trying to protect their interests I would simply consider Occam’s razor. What is more probable: pharmaceutical companies don’t want to have a product produced that could easily be usurped and sold for many billions of dollars or the snake oil just doesn’t work?
Fun fact: when getting a new drug approved it must be tested against a placebo (i.e. sugar pill) in order to show efficacy. Without getting into too much boring detail, in pathological states that are largely subjective (i.e. depression, pain, attention) placebo shows a 30% efficacy across the board. In other words, 30% of people get subjective (and objective) relief from the idea of taking something that might help. This is a real pisser for pharmaceutical companies because it is many times hard to tease out superiority of one’s drug over placebo without conducting very large (and expensive) clinical studies.
As for allergy shots, its scientific basis is on regulation of various antibodies. There are antibodies in your blood that react to allergens to give you ‘allergies’ (IgE antibodies react in the body to release histamine and all the wonderful following effects). Allergy shots work by up regulating a different type of antibody (IgG, usually used to fight off colds, viruses and infections) that binds to said allergens without releasing histamine. By ratcheting up the doses of allergens you get higher amounts of IgG that essentially outnumber the IgE antibodies (so you no longer get the usual effect from ‘allergies’).
As for why these assholes don’t get sued, Sen Oren Hatch (Utah) sponsored the bill (DSHEA) that neutered the FDA and its ability to bitch-smack these charlatans (and also responsible for the fine print across the bottom of the TV screen that says something along the lines of ‘These claims have not been evaluated by the FDA’; some of the more forthright ones will also include that caveat ‘do not use to treat an actual disease’). This ultimately allows that claim ‘I am not trying to cure any disease, I am just helping people with medical choices’ to be used as a legal defense. Unfortunately, the industry has matured enough to thoroughly cover its ass in that regards.
Fun fact: Utah is the home to a majority of these ‘naturceutical’ companies. Ah yes, a great example of where religion and stupidity are two great tastes that go great together!

Posted by: Doc Jensen at June 6, 2007 9:25 PM

Fantastic-- I came back to check on this super woman ( Guilty While Breathing and Male) and I find you are at the Human Behavior and Evolution Society Conference. WOW ! You have to be the ultimate babe ! To understand human behavior-- especially sex differences in everything--- you have to take an evolutionary approach. I have never heard of a journalist who was so sharp as to go to such a conference-- heck, 90% of the "intellegentsia" wouldn't have the sense to attend this conference-- or would even understand anything that was said.
("Personality and Individual Differences" is a good journal to look at too.)
Not anti-male, seems to like men, intelligent, witty, humorous and into evolutionary psychology-- the perfect woman !

Posted by: jay edwards at June 6, 2007 11:03 PM

Awww, thanks. And I'm working day and night, not only on my column, but on getting a book out (my agent should be taking it to publishers this month), but as soon as I get a breather I'll start posting about the sessions there...including an evolutionary approach to legal policy from a fascinating talk by Owen Jones.

And regarding Orin Hatch -- great post Doc J...great to have you back. Orrin Hatch is the senator from Utah...the nature-ceutical protection thing is, of course, all about the money.

My 2 cents about homeopathy is that it's just another way for snake oil salesmen to get your money. However you have to be careful about the term 'alternative medicine' because, diet and exercise are alternative medicine for obesity here in Canada. Untested, or under-tested and unregulated pills are the conventional therapy, followed closely by life threatening surgery.

You want an example of how big pharmaceutical companies, look out for you? There's a drug that will cure a certain type of brain tumor in kids, 90% of the time. It is safe with few side effects but because it is 'too expensive' to make is now off the market. Despite that several no-name companies, tried to buy the formula.

Posted by: Pixilated at June 7, 2007 10:08 PM

Pixilated-

Without any specifics your tale of the drug too expensive to make sounds like an urban legend. But it does illustrate a point where I disagree with you (and with most tabloid newspapers) - namely that a life-saving drug could possibly be too expensive. Life is priceless, right?

Wrong. We may not like the idea, but there is a limit to how much a life is worth. It's worth different amounts to different people of course. But it would not be sensible, for example, to spend billions and billions of dollars to save one person. To do that would require other people working for years to raise the money - it's got to come from somewhere - and of course, dying in industrial accidents etc to do so. On the other hand it would easily be worth one dollar to save a person. Somewhere between one and billions and billions there is a cut-off point where the balance tips. Life is not priceless; we just disagree about the price.

And I tried to Google this drug you're talking about Pixilated. If you have a link, please post it. It does sound like an urban legend to me. And if it's not, who should pay for it? The pharmaceutical company? Is your business in the business of charity, Pixilated? Somebody has to pay. And where does it end? We keep people who are very old and suffering alive...and Dr. Kevorkian goes to jail for ending the lives of people who were begging to die.

I tried to google Pixilated's story about the drug against brain tumors. The closest thing I can find is a report by the Brain Tumor Society from 2005:

"A drug used for decades to treat intestinal inflammation may also work against the most common and malignant type of brain tumor, UAB researchers reported Tuesday in the journal Neuroscience. [..] If it works on humans, the drug would not be a cure, but it could add years to the lives of patients with brain tumors, [Harald Sontheimer] said. As it stands now, glioblastoma patients often live only a few months without treatment. Aggressive surgical and radiation treatment can prolong their lives, but usually only by months."

No conspiracy involved, though: They're still conducting human trials. The link is here.

Posted by: Rainer at June 9, 2007 4:34 AM

If you're going to make an interesting statement, Pixilated, you're going to have to supply data to back it up. We're all pretty darn smart around here, and tend to ask questions.